"Double vision" as a presenting symptom in adults without acquired or long-standing strabismus

Evaluation of adults with a symptom of acquired double vision is a challenging diagnostic problem. This retrospective report reviews a series of adult patients who presented with a symptom of "double vision" but did not have diplopia related to a recently acquired or decompensated strabismus. The symptom of double vision was related mainly to blurred vision and often was not true binocular diplopia.

This is a retrospective study of medical records.

261 patients, age 40 years or older referred for a recent onset symptom of double vision were reviewed. Sixty-seven patients were included in the study. These patients presented with no findings that indicate a recent onset of incomitance or breakdown of a long-standing strabismus. The patients were divided into five groups with common etiologies and their findings were analysized. Group 1 (17 patients) had symptoms of double vision due to monocular blur without diplopia. Group 2 (21 patients) had symptoms of double vision related to monocular blur that caused a dissociation of a small phoria. Group 3 (10 patients) had symptoms of double vision related to superimposition of images due to a distorted image. Group 4 (13 patients) had symptoms of double vision related to convergence insufficiency. Group 5 (6 patients) had symptoms of double vision related to an induced tropia secondary to anisometropia correction. Options for treatment include improving vision and having the patient understand the nature of the problem.

"Double vision" does not mean the same thing to the patient and the examiner. The examiner must distinguish true diplopia from other symptoms and be able to demonstrate this to the patient. Treatment is directed to the specific type of problem, but improvement of vision resolves the large majority of these complaints. Examination and treatment techniques are discussed.